This week, the United States could learn a lot from a UK town about preventing unintended pregnancies, the United Arab Emirates is mandating that women breastfeed their children for a full two years, and a study looks at sex after breakups among college students.

This Week in Sex is a weekly summary of news and research related to sexual behavior, sexuality education, contraception, STIs, and more.

Lessons From the UK on Reducing Unintended Teen Pregnancies

Sexuality educators and public health experts have long argued that reducing unintended teen pregnancy rates takes an all-hands-on-deck approach—one that combines sexuality education, contraceptive access, and public education. One town in the United Kingdom, which was once considered the “teen conception” capital of England, has done just this and has seen a 42 percent drop in teen pregnancy over the last decade.

In 1998, 218 teens under age 18 in Swindon gave birth, but by 2011-2012 the number was down to 118. The teen pregnancy rate (referred to in the UK as the teen conception rate) dropped to 25.2 per 1,000 young women under 18, which is lower than the national rate for England of 29.4 per 1,000 young women.

This sharp drop is largely credited to a community-wide effort to educate young people about contraception and give them access to methods. The Swindon Health Centre holds dedicated clinics each week for those under 20, but more than that, outreach nurses visit young people at home, school, and college. Resources have also been dedicated to making long-acting reversible contraceptive methods (LARCs), such as intrauterine devices (IUDs) and implants, available, as these methods are the most effective in preventing pregnancy.

Schools are also playing an important role. Sex education has been prioritized and school nurses have been drafted into the efforts. Nurses work to connect young people to outside services, but they also provide education and advice as well as emergency contraception and condoms.

This is the kind of holistic approach that communities here in the United States should be trying, and while some are, all too often such efforts (especially those that make condoms and contraception available at school) become controversial and are cancelled because of misplaced fears that they will increase sexual behavior.

United Arab Emirates Mandates Breastfeeding

The United Arab Emirates’ Federal National Council has passed a clause to a child rights law requiring new mothers to breastfeed for a full two years. The clause allows men to sue their wives if they don’t breastfeed.

The benefits of breastfeeding, especially in the newborn phase, are well-known and widely accepted. Most major medical associations around the world, including the World Health Organization, recommend breastfeeding and call on governments to make policies that support women in their efforts to do so. These organizations do not, however, suggest that women be forced to breastfeed.

The law is said to apply only to women who can breastfeed, but it is unclear who makes that determination for individual women. It states that women who are prohibited from nursing for health reasons will be provided with a wet nurse, but some critics have questioned how this arrangement will work, practically speaking. It is also not yet known whether the rule will mean that formula—which many mothers rely on either instead of or in addition to breast milk—is no longer legally sold in the country.

In an editorial in The National, a local breastfeeding advocacy group expressed concern over the law:

As a group we wholeheartedly agree that breastfeeding should be encouraged and that the sentiment is a good one that clearly follows international guidelines. However, as many of the new mothers we encounter are already under significant pressure, we are concerned that enacting a law that leaves mothers facing potential punishment could be a step too far.

It is our opinion that, while encouraging women to breastfeed is a laudable aim, it is by supporting those who can and want to breastfeed, and not by punishing those who can’t, that we will reap the benefits we all want to see in our society.

I expressed a similar opinion in an article for RH Reality Check after a British program announced plans to monetarily reward low-income women who breastfeed for six months. We should encourage breastfeeding with supportive policies and practices, but we should not make women feel guilty for making another choice, and we certainly should not punish them for it.

Breaking Up Is Hard to Do, So College Students Turn to Sex

A new study looks at sex after breakups. Researchers asked 170 University of Missouri students who had recently ended serious relationships to keep an online daily journal of their distress levels, their self-esteem, and their sex lives for one semester. Two-thirds of the newly single students reporting having sex during the ten-week study. Of those, 54 percent had sex with someone else they had hooked up with in the past, 26 percent had sex with someone totally new, and 20 percent had sex with their ex. Those who had sex cited both getting over their ex and getting back at him/her as their motivation, but soothing sadness was more common than revenge. The study also found that those who were most distressed by the breakup (often those who were broken up with) were more likely to have sex as were those who were just out of relationships that lasted more than a year.

There is a little bit of good news for the romantics out there, especially those who are fond of sex with their ex: Some participants had to drop out of the study because after having rebound sex with their ex, they got back together.

]]>http://rhrealitycheck.org/article/2014/01/31/week-sex-comprehensive-approach-unintended-pregnancy-mandated-breastfeeding-sex-breaking/feed/0Is Better Access to Sex Ed and Contraceptive Methods Behind the Latest Significant Decline in Abortion Rates?http://rhrealitycheck.org/article/2012/12/12/what%E2%80%99s-behind-latest-significant-decline-in-abortion-rates/?utm_source=rss&utm_medium=rss&utm_campaign=what%25E2%2580%2599s-behind-latest-significant-decline-in-abortion-rates
http://rhrealitycheck.org/article/2012/12/12/what%E2%80%99s-behind-latest-significant-decline-in-abortion-rates/#commentsWed, 12 Dec 2012 19:37:50 +0000Does the decline in abortion rates indicate better reproductive health choices and outcomes for women? And if so, how do we continue to build on this success?

]]>The latest Centers for Disease Control and Prevention (CDC) figures indicate not only the lowest current rate of abortion in the United States, but also the largest drop in the rate in 10 years. It will be difficult to determine the precise reason for this trend. As with most public health issues, but especially those that relate to sexual and reproductive health, there are myriad of potential explanations for the decline. The most important questions we need to ask now are: Does the decline in abortion rates indicate better reproductive health choices and outcomes for women? And if so, how do we continue to build on this success?

Researchers have shared several theories behind the decline. Some believe the economic recession has affected reproductive decision-making. A Washington Post report suggests that women are making decisions to continue their pregnancy rather than terminating.

CDC says the decline is due to more effective contraception and increased access and use by women. A study from the journal Fertility and Sterilitysupports the CDC view with the finding that the use of long-acting contraceptives such as intrauterine devices had tripled between 2002 and 2009, with most of this increase happening within the last two years. These data suggest that our efforts in primary prevention are paying off, which is, to me, perhaps the most hopeful explanation.

It is interesting to note that trends in abortion rates match the current trends in teen pregnancy rates. The teen pregnancy rate and the teen birth rate have declined by more than 40 percent since the early nineties, according to The National Campaign to Prevent Teen and Unplanned Pregnancy. The decline, says National Campaign Chief Program Officer Bill Albert, is due to the “magic combination of less sex and more contraception.”

There is a way to keep the trend going. Research tells us that information has a protective effect, and information plus the availability of contraception reduces teenage pregnancy, STDs, and abortions. The data leads to some inescapable conclusions: repressed sexual culture equals earlier sex, less ability to refuse sex, more unwanted pregnancies and thus more abortions. Effective sex education programs have been shown to decrease sexual activity and to increase contraceptive use among those already sexually active.

So young people need information, that much is clear. Who do they get it from? John Snow, Inc. has conducted two studies which explored issues and factors associated with choosing birth control methods and unintended pregnancy in two Colorado counties. Two key messages came out of these studies. The first is that young women (and men) want information about making healthy choices if they decide to become sexually active; and secondly their parents and health care providers are their most trusted sources of information. These results are similar to National Campaign findings.

Participants in the JSI study underscored the value of providers. Here is one participant’s comment:

“I think doctors should spend more time talking about birth control. Even if it’s just 15 minutes, like this is what it is, this is what it’s going to do to you, this is what it may cause for you. Because for them, what’s that? What’s five minutes to them for a lifetime to someone else? That right there could change someone’s life. They’re getting paid good money, why don’t they sit there for another 10 minutes? It’s not going to hurt.”

The information imparted during a contraceptive method visit is very important, as it enables women to choose and employ contraception with satisfaction and technical competence. A long-running quality improvement project with Title X Family Planning clinics found that a lack of information is a reason for discontinuing method use, and belief in rumors may be a deterrent to use altogether. The common response in this study was that women would like more information about the method that they are going to use so that they can make sure that it will fit into their lifestyle, among other considerations.

Reducing unintended pregnancies, particularly among adolescents, would improve educational and employment opportunities for women which would, in turn, contribute to improving the status of women, increasing family savings, reducing poverty and spurring economic growth. We have to end our taboo on open, honest conversations about sex because the stakes are too high.

]]>http://rhrealitycheck.org/article/2012/12/12/what%E2%80%99s-behind-latest-significant-decline-in-abortion-rates/feed/8Unintended Pregnancy Rates Linked to Proportion of Women Uninsured or on Medicaidhttp://rhrealitycheck.org/article/2012/02/07/unintended-pregnancy-rates-linked-to-proportion-women-uninsured-or-on-medicaid/?utm_source=rss&utm_medium=rss&utm_campaign=unintended-pregnancy-rates-linked-to-proportion-women-uninsured-or-on-medicaid
http://rhrealitycheck.org/article/2012/02/07/unintended-pregnancy-rates-linked-to-proportion-women-uninsured-or-on-medicaid/#commentsTue, 07 Feb 2012 09:09:48 +0000A new analysis from researchers at the Guttmacher Institute found that states' unintended pregnancy rates are related to the proportion of women in the state who are uninsured and receiving Medicaid.

]]>A new analysis from researchers at the Guttmacher Institute found that states’ unintended pregnancy rates are related to the proportion of women in the state who are uninsured and receiving Medicaid.

The rates of unintended pregnancy vary widely across states and research has found that some women have much higher rates of unintended pregnancy than others. Specifically, black and Hispanic women and women living in poverty experience higher rates of unintended pregnancy. Researchers conducted the current analysis to determine whether a state’s demographic and socioeconomic make up was related to its rates of unintended pregnancy.

Though their initial analysis revealed a strong relationship between a state’s ethnic composition and its unintended pregnancy rates, further analyses showed that most of this relationship was accounted for by other factors. What did remain significant, however, was the proportion of women in a given state who receive Medicaid and are uninsured. This was strongly associated with the state’s unintended pregnancy rate. Specifically, the researchers found, “the greater the proportion of women who lacked insurance, or the lower the proportion covered by Medicaid, the higher the unintended pregnancy rate.”

According to the authors, these findings suggest that states look at efforts to expand insurance and Medicaid coverage among groups with high levels of unintended pregnancy as a possible way to lower these rates.